Latest / The Art of Adjusting® Podcast / Episode #97: CMS Reporting And Medicare Liens For Liability Claims

Transcript

Episode #97: CMS Reporting And Medicare Liens For Liability Claims · The Art of Adjusting® Podcast

• 0:06
  William Auten: Hello, I'm Bill Aughton of Autin Claims Management.
• 0:09
  Chantal Roberts: I'm Chantel Roberts of CMR Consulting, and welcome to the Art of Adjusting Podcast.
• 0:14
  William Auten: Today we're going to talk about life as an insurance adjuster from the perspective of property, auto, liability, or workers' compensation adjusters.
• 0:22
  William Auten: Our goal is to bring interesting topics in the world of claims adjusting to people who are working as an adjuster now and to people who are considering a career as a claims adjuster.
• 0:32
  William Auten: Good morning.
• 0:33
  Chantal Roberts: Good morning.
• 0:34
  William Auten: How are you today?
• 0:36
  Chantal Roberts: I am having a day.
• 0:37
  Chantal Roberts: How are you?
• 0:38
  William Auten: I'm having another day too.
• 0:40
  William Auten: It's it's this is fantastic.
• 0:42
  Chantal Roberts: I love it when we're having days together.
• 0:44
  William Auten: Yeah, yeah.
• 0:45
  William Auten: As long as the heat, the feet hit the floor, uh, things are good.
• 0:48
  Chantal Roberts: Man, I tell you what, uh, yeah, it was it was very good.
• 0:52
  Chantal Roberts: My um husband let me sleep in today, and I woke up about an hour ago and I'm like, crap, I gotta go.
• 0:59
  Chantal Roberts: I gotta podcast to do.
• 1:02
  William Auten: Rush, rush.
• 1:03
  William Auten: We're on a tight schedule here, Chanto.
• 1:05
  Chantal Roberts: I know, right?
• 1:06
  Chantal Roberts: I know.
• 1:07
  Chantal Roberts: It's it's it's terrible.
• 1:08
  Chantal Roberts: Uh sleeping princess, such that I am, you know, eating bonbons all day long, just waiting to do a podcast, uh, which is what we're doing today.
• 1:18
  Chantal Roberts: And we're gonna be talking about a topic that may not interest some adjusters, uh, like the on the property side of things, but I think that you should still stick around, listen to it.
• 1:31
  Chantal Roberts: We'll try to make it interesting.
• 1:33
  Chantal Roberts: We are talking about the government, so there's only so much we can do to keep it interesting.
• 1:39
  Chantal Roberts: Yeah, but but um we're gonna be talking about CMS.
• 1:44
  Chantal Roberts: Uh that's the center of um oh, medical, Medicaid, Medicare um services, center of Medicare Services, I think.
• 1:55
  William Auten: CMS centers for Medicare and Medicaid Services.
• 1:58
  Chantal Roberts: Yes.
• 1:59
  Chantal Roberts: Um, so we're talking about Medicare, Medicaid, liens, um, subrogations and liability and uh essentially what these adjusters, usually liability adjusters, need to know, but I want the property damage adjusters to sit up and pay attention in case y'all ever like switch lines, which I always encourage you to do, so you can become a multi-lined adjuster and become even more indispensable as you are.
• 2:30
  William Auten: It's important for adjusters to know this, but I I think it's equally as important for injured people to understand this too.
• 2:38
  Chantal Roberts: So I absolutely agree with that.
• 2:41
  William Auten: One thing you're gonna kick things off with is this big five.
• 2:44
  William Auten: I need to know what the big five is.
• 2:45
  Chantal Roberts: Yes, I am, but and and while we're talking about it, uh the injured person to know about it.
• 2:51
  Chantal Roberts: Agents need to know about it, uh, because they might get called by their insureds going, like, why does this adjuster want to know all of my business?
• 3:02
  Chantal Roberts: And attorneys need to know this because when I was a liability adjuster, I got a lot of pushback from attorneys.
• 3:09
  Chantal Roberts: And there's there's some good reasons why we are asking these questions.
• 3:13
  Chantal Roberts: Okay, so remember to like, comment, subscribe, share with all of your friends, especially because this is like really important.
• 3:20
  Chantal Roberts: So we're gonna start off with some spoiler alerts.
• 3:22
  Chantal Roberts: What the big five is.
• 3:24
  Chantal Roberts: Okay, so the big five is something that a an adjuster needs to know about the claimant essentially right off the bat.
• 3:34
  Chantal Roberts: And it's one of the first questions that we as liability adjusters are going to be asking the claimant.
• 3:40
  Chantal Roberts: It is your name, your full name.
• 3:43
  Chantal Roberts: Uh and I always called it your name, rank, serial number kind of deal.
• 3:47
  Chantal Roberts: Your full name, your date of birth, your um uh see, now you're catching me like all off guard because I'm like going to the case.
• 3:57
  William Auten: Now I know now I know what it is.
• 3:58
  William Auten: So I can I can receive it.
• 4:01
  William Auten: Your name, your name of birth, address, phone number, date of birth, social security number.
• 4:06
  William Auten: Yes.
• 4:07
  Chantal Roberts: Uh and and and the reason is these are your big fives.
• 4:10
  Chantal Roberts: Okay, your name, date of birth, gender, gender, social security number, or partial um Medicare identification number, if you have that, yeah, and then um address whatever.
• 4:24
  Chantal Roberts: These are your big five.
• 4:25
  Chantal Roberts: These are the things that identify you.
• 4:30
  Chantal Roberts: And the reason I say that agents need to know this, attorneys need to know this, uh, claimants, like you said, uh the the injured person needs to know this, is because the adjuster is going to be asking you this.
• 4:46
  Chantal Roberts: And some random person is gonna be calling you saying, Hey, can you give me your uh date of birth, your driver's license number, your social security number, your Medicare number if you have it, you know, any of that kind of stuff.
• 5:00
  Chantal Roberts: And we all go to our uh uncle who lives in Nigeria, who um is gonna leave us all of his money.
• 5:11
  Chantal Roberts: All we got to do is give him the same information along with our bank account number, right?
• 5:16
  Chantal Roberts: Right.
• 5:17
  Chantal Roberts: That's the first thing we think of.
• 5:19
  Chantal Roberts: And and so you're going to understand that this random person is just giving you a call after you've had this accident.
• 5:29
  Chantal Roberts: They say that they're with the insurance company.
• 5:32
  Chantal Roberts: You don't know.
• 5:33
  Chantal Roberts: So, as an adjuster, of course, what I always said is like, look, this is this is what I need.
• 5:39
  Chantal Roberts: I'm gonna need it, it's called the big five.
• 5:41
  Chantal Roberts: Uh, this is why I need it.
• 5:43
  Chantal Roberts: I need it because I have to run you through the Medicare services, the CMS services.
• 5:51
  Chantal Roberts: And um, the the reason why I have to do this is we'll get into it just a minute.
• 5:59
  Chantal Roberts: But if you're not comfortable giving all of that information to me, know that I'm gonna send you a letter that explains all of this.
• 6:08
  Chantal Roberts: And still, some people are not comfortable giving their social security numbers out with everything that's going on nowadays, especially nowadays.
• 6:20
  Chantal Roberts: I mean, they can clone your voice, right?
• 6:22
  William Auten: Right.
• 6:23
  Chantal Roberts: And um so you can even give a partial social, but it's not the last four, it's the last five.
• 6:32
  William Auten: Five, yeah.
• 6:32
  Chantal Roberts: I don't know why the government likes five, but they do.
• 6:35
  Chantal Roberts: They they like five.
• 6:37
  Chantal Roberts: It's it's a thing with the government that you know you we would probably get 555 pages if we asked them why.
• 6:44
  Chantal Roberts: I don't know.
• 6:45
  Chantal Roberts: I'm just saying it.
• 6:46
  William Auten: It's funny because we have um we we request medical records with standard authorizations, and uh, on those authorizations, a lot of attorneys will leave the social security number off.
• 7:00
  William Auten: And a lot of the healthcare providers will not respond if it's not on there.
• 7:04
  William Auten: Right.
• 7:05
  William Auten: So some attorneys have opted for the last four, and that narrows the pool down, but there's still some sticklers out there, these um hospitals, whatever clinics, that they just won't release it unless it's the full social.
• 7:22
  William Auten: And we go back to the attorney and they say, Well, that's not true.
• 7:26
  William Auten: And okay.
• 7:27
  William Auten: Oh, wait, that's here's the letter they sent me.
• 7:29
  William Auten: Uh yeah, yeah, yeah.
• 7:32
  William Auten: So it it is, you know, there's a couple reasons why we have to get that information, is my point.
• 7:39
  Chantal Roberts: Absolutely.
• 7:40
  Chantal Roberts: I mean, it we start off.
• 7:43
  Chantal Roberts: Let's let's take a step back and and start off with why we need it since we've already teased.
• 7:50
  Chantal Roberts: This is the spoiler, this is the answer.
• 7:54
  Chantal Roberts: Right there, the first five minutes.
• 7:55
  Chantal Roberts: Woo! So now don't turn us off.
• 7:57
  Chantal Roberts: We're we're gonna keep on going, telling you why, because that's that's the important part, because this is the important part that the that you need to know to be able to explain to the um attorney and to the claimant and and to and even to the agent, because again, a lot of times as adjusters, we're not the ones being trusted.
• 8:20
  Chantal Roberts: You know, we're not the ones in town.
• 8:22
  Chantal Roberts: They uh, you know, the insured may go over to the agent's office if there is still an office there.
• 8:27
  Chantal Roberts: Okay, so um what happens is you get into a car accident or you trip and fall and you have some kind of accident, right?
• 8:36
  Chantal Roberts: Um, or you slip and fall, or whatever.
• 8:39
  Chantal Roberts: And the um adjuster, the insurance company has to prove that you as a claimant are not a Medicare or Medicaid recipient.
• 8:54
  Chantal Roberts: And you're like, I'm 35.
• 8:57
  Chantal Roberts: I'm like, yeah.
• 8:59
  Chantal Roberts: And this is where the attorneys come in.
• 9:01
  Chantal Roberts: Um, so attorneys that are listening, you'll go, my client's 35.
• 9:05
  Chantal Roberts: And I'm like, yeah, don't care.
• 9:07
  Chantal Roberts: Doesn't matter, do not, do not care.
• 9:10
  Chantal Roberts: Um, and you can be a little bit more polite, adjusters, than than I ever was with my attorneys, but I would just go, don't care, do not care.
• 9:19
  Chantal Roberts: You can be three years old, and I want to know what your um social security number is, because because the fine, and this is where um we get some teeth, because uh there is a lien, the government automatically has a lien on the payments that you make to a claimant or whatever, if they have made payments, and this was the subrogation part of it, right?
• 9:49
  Chantal Roberts: And it's called like that super lien.
• 9:51
  Chantal Roberts: And back in the day, uh when I first started, and Bill, probably when you first started, I mean, we knew about it, you know, but like nobody wanted to bother the government.
• 10:01
  William Auten: It was it was not formalized like it is today.
• 10:04
  Chantal Roberts: Exactly.
• 10:06
  Chantal Roberts: We knew that there was a lien.
• 10:09
  William Auten: Yeah, we would um there was a process, but I think we usually left the attorneys to go find it.
• 10:18
  Chantal Roberts: Um see, so that that is exactly it.
• 10:21
  Chantal Roberts: And the attorneys, God bless their hearts, bless their hearts, didn't really do anything about it.
• 10:28
  Chantal Roberts: They didn't repay the government, and the government said, yeah, no, that's not gonna work for us anymore.
• 10:33
  Chantal Roberts: So we're gonna need you to repay us.
• 10:36
  Chantal Roberts: Okay.
• 10:37
  Chantal Roberts: And so they formalized all of this.
• 10:41
  Chantal Roberts: And so what they did was um they said, yeah, if you don't repay us, it is going to be a thousand dollars a day fine.
• 10:54
  Chantal Roberts: Per claim per claim a day, and we don't care if we get it from the attorney or the insurance company or the third-party administrator, or well, the those those fines are actually for the insurer for the responsible reporting entity, the RRE.
• 11:14
  William Auten: Yes, so uh they're the ones that that as far as fines for attorneys representing clients.
• 11:20
  William Auten: I don't know.
• 11:22
  Chantal Roberts: I've always been told it was for everybody, but there is an RRE, like the government can go against anybody, is what I was always told.
• 11:29
  Chantal Roberts: So you may know more information than I, but what I was always told it was for anybody, and yeah, I don't know if the if an attorney qualifies as an RRE or not.
• 11:39
  William Auten: That's something I'd have to look up.
• 11:43
  William Auten: We should probably back up a little bit here because there's let's throw out some vocab words.
• 11:47
  William Auten: If there's any uh property people here um that uh want to understand this better, your your ears might be bleeding by now.
• 11:55
  William Auten: So we'll we'll back the truck up a little bit.
• 11:58
  Chantal Roberts: We get ahead of ourselves, don't we?
• 12:00
  Chantal Roberts: We're so sorry.
• 12:01
  William Auten: We do, we did.
• 12:02
  William Auten: We started at the at the end, and now we're in the middle.
• 12:05
  William Auten: So um, but the the concept to to understand is this is basically no different than the subrogation situation.
• 12:13
  William Auten: And uh Medicare, Medicaid, workers' compensation, and in some states, health insurance companies have a right to subrogate for damages that they pay when someone else is responsible for the accident that caused the injuries.
• 12:28
  William Auten: So very simple concept there.
• 12:31
  William Auten: Um, the difference is with these entities, it's um it's a government responsibility.
• 12:38
  William Auten: And um the government says, well, there's too many claims, so it's not our job to go find the subrogation uh opportunities.
• 12:49
  William Auten: We're gonna put a law in place that requires all these liability insurers that if you see something, you've got to tell us, which is a little bit of a different scenario because if you've got a an auto accident claim and you insure car A, who's at fault in the accident, the insurer for car B is gonna be looking uh to recover anything they paid and they're gonna go find you.
• 13:13
  SPEAKER_01: Right.
• 13:13
  William Auten: With Medicare, it's different.
• 13:16
  William Auten: The the they want you to let them know that you owe them money.
• 13:21
  William Auten: So um that's a a little bit of a different uh of a role reversal there.
• 13:26
  Chantal Roberts: I I do I did look this up because uh I know that the government loves their acronyms, and and so I uh was looking it up, and this is one of the fun things that Bill and I were talking about is I said, Hey, I did this whole you know outline, because as everybody knows, we we we go off of outlines, and uh he's like, Yeah, I did too.
• 13:49
  Chantal Roberts: And I'm like, oh, well, that means that I didn't forward you my outline.
• 13:52
  Chantal Roberts: So hey.
• 13:54
  Chantal Roberts: Um, but I I always got confused with all of these acronyms that the government starts throwing around, right?
• 14:02
  Chantal Roberts: Because the government, like, like they like the number five, also love their acronyms.
• 14:07
  Chantal Roberts: And so CMS, the centers of Medicare, Medicaid Services, is the federal agency that runs Medicare.
• 14:17
  Chantal Roberts: Now, they use section 111 uh reporting to identify claims involving Medicare beneficiaries and to protect Medicare's interest when another insurer may be responsible.
• 14:31
  Chantal Roberts: And that's what Bill was just talking about.
• 14:33
  Chantal Roberts: So this section 111 is the federal Medicare secondary payer, which is the MSP reporting requirements.
• 14:45
  Chantal Roberts: So it like branches off into that.
• 14:48
  Chantal Roberts: And uh that's when we figure out what the rules are, and so the the nuance that we're getting at here is is this person meaning the injured person the actual Medicare beneficiary?
• 15:05
  Chantal Roberts: And do I have enough information to verify whether they are a Medicare beneficiary?
• 15:10
  Chantal Roberts: Um and so that's where we were getting off into the big five.
• 15:16
  Chantal Roberts: Now, Bill, you want to tell us what a R R E is, which is another acronym.
• 15:22
  Chantal Roberts: There's gonna be a test later, guys, by the way.
• 15:27
  William Auten: It is uh it is a responsible reporting entity, and that means that under the MSP or the CMS well, Section 111 laws, that you are or your entity has to report these um payments to uh to CMS so that they they can send you a letter and let you know about all the payments that they've made.
• 15:53
  William Auten: And what's interesting I'm sorry.
• 15:56
  Chantal Roberts: I'm sorry.
• 15:58
  William Auten: Well, what's interesting is that they call them conditional payments.
• 16:03
  William Auten: So as they're paying for an injured person's medical care, and that if that injured person was hurt because of someone else's negligence, those payments are considered conditional, meaning that Medicare is paying it now because we want them to get their treatment, but we expect it back, is the is the kind of the idea.
• 16:29
  William Auten: Um so it's conditional on what the existence of other insurance of other benefits that may be available.
• 16:38
  William Auten: Um even if there's like other health insurance, although I don't think that happens very often if you're on Medicare and you happen to have, you know, fine coverage somewhere else that you, you know, some b policy buried in the back drawer that you never knew about, I guess.
• 16:54
  William Auten: Um, but most often it's liability.
• 16:57
  Chantal Roberts: Yeah.
• 16:58
  Chantal Roberts: So let's back up again, real quick.
• 17:00
  Chantal Roberts: And one of the things that I wanted to mention, because I didn't want all of the adjusters to go, holy cow, I'm not doing any of this.
• 17:10
  Chantal Roberts: You probably are, you just don't realize it.
• 17:13
  Chantal Roberts: And and then the the other thing is is that I don't want you as an adjuster to think that you personally are the RRE, because and you're thinking, oh my God, I'm not contacting Medicare or the CMS or this Section 11 or you know, whatever.
• 17:32
  Chantal Roberts: No, no.
• 17:33
  Chantal Roberts: Um when I was working at Liberty Mutual, MetLife, and then even as my third party administrator, um, what what I would do is I would input this information into the system, into our claim system, uh, and then nightly it would go over to the chosen RRE.
• 17:59
  Chantal Roberts: And there's a couple of different ones throughout the insurance industry.
• 18:03
  Chantal Roberts: Um, I don't know if we want to mention names or whatever, but uh it's usually not the insurer, they usually like sub that out to someone, and that other company is the RRE.
• 18:21
  William Auten: And so it it that's partially true, but what at the outset, yes, the RRE uh uh original RRE at the base of it is the insurance carrier.
• 18:34
  William Auten: This is true.
• 18:35
  William Auten: This is true.
• 18:36
  William Auten: They contractually then um give that responsibility to some other vendor who has the tech available to be able to populate CMS with this data.
• 18:48
  William Auten: So it becomes this big tech nightmare.
• 18:50
  William Auten: When it first started, this was like 2009, I think.
• 18:54
  SPEAKER_01: Yeah.
• 18:54
  William Auten: 2009 or 10.
• 18:57
  William Auten: At the company I was at, we didn't have that tech.
• 19:00
  SPEAKER_01: Right.
• 19:01
  William Auten: It's a very small company.
• 19:02
  William Auten: So we would log in, we would set up an account with CMS and we would log in and literally report each claim that way.
• 19:13
  Chantal Roberts: Yeah, yeah, yeah.
• 19:14
  William Auten: And then after a few years, they stopped that portal, was no they they they eliminated it.
• 19:20
  William Auten: They're like, well, not enough companies are even using it.
• 19:24
  William Auten: So most of them are doing this data dump.
• 19:26
  SPEAKER_02: Yes.
• 19:27
  William Auten: So I spent the next five years at my company trying to get the tech in place to do that.
• 19:32
  William Auten: Right.
• 19:32
  Chantal Roberts: So and and that's why I say a lot of these companies, um it's all operating behind the scenes for the adjust from the adjuster's point of view, from the agent's point of view, from the attorney's point of view, all of that kind of stuff.
• 19:47
  Chantal Roberts: But there are these these other entities that that take your data as an insurer and report it off.
• 19:55
  Chantal Roberts: Now, I'm assuming that a lot, and I guess that's true.
• 19:59
  Chantal Roberts: I shouldn't assume this, that a lot of our adjusters listening uh might be desk adjusters or independents who gather this big five and then turn it over to the desk adjuster who then turns it over.
• 20:14
  Chantal Roberts: And I shouldn't assume that.
• 20:16
  Chantal Roberts: So but but I also don't want the adjuster listening going, holy heck, I'm I'm not contacting Medicare or the CMS or data dumping or anything like that.
• 20:31
  Chantal Roberts: Um yes, while it is the insurer that that is supposed to be doing this, it's your duty is really only to get this this data.
• 20:44
  Chantal Roberts: And then once it gets dumped, um, you will either get a yes or no from CMS saying, yes, this person is Medicare eligible and we're we're making payments, or no, this person is not eligible and we're not making payments.
• 21:05
  Chantal Roberts: And um that's when you can go, oh, thank God, they're not medical, they're not Medicare Angels.
• 21:16
  Chantal Roberts: And and FYI guys, um this system that we're talking about, we keep saying Medicare, which is the the elderly one or the end of life one.
• 21:30
  Chantal Roberts: Um, but the states do usually have a Medicaid one.
• 21:35
  Chantal Roberts: And I don't want to get too much into that one because it's like a that's a whole nother podcast.
• 21:40
  Chantal Roberts: Uh well, it's something similar.
• 21:43
  William Auten: Yes, um you kind of need the same information.
• 21:47
  Chantal Roberts: You do.
• 21:48
  William Auten: Um in New York, it's it's um so first of all, the the Medicaid is always ran by the state versus Medicare, which is federal government.
• 21:59
  William Auten: So With Medicaid here in New York, it's administered through each county.
• 22:06
  William Auten: So if you have a claim in Monroe County, you would go to the health department in Monroe County.
• 22:12
  William Auten: Wow.
• 22:12
  William Auten: I happen to know there's a single attorney there whose only job is to inform you with these liens.
• 22:20
  William Auten: I know her name, I know her phone number.
• 22:21
  William Auten: She just says, call me when you have one.
• 22:23
  SPEAKER_02: Wow.
• 22:23
  William Auten: So we call her and then she sends a um the lien letter to us.
• 22:29
  William Auten: Other counties are different.
• 22:30
  William Auten: You have to do kind of like a FOIL request, FOIA request.
• 22:35
  William Auten: Um but you're basically asking for the information about any liens that are that would be on there.
• 22:41
  William Auten: So that's for Medicaid.
• 22:44
  William Auten: Workers' compensation is also eligible to subrogate uh for benefits that they've paid.
• 22:53
  William Auten: But that's different.
• 22:54
  William Auten: That's more like a traditional subrogation situation.
• 22:57
  William Auten: You're not uh we're not obligated to go find the workers' compensation carrier uh like we are with Medicare and Medicaid, but um they do have a right to subrogate uh uh for for you know uh medical bills and things that they've paid.
• 23:13
  William Auten: Uh plus wages um are a component of that of that too.
• 23:18
  William Auten: Health insurance companies in New York cannot subrogate.
• 23:24
  William Auten: So private health insurance like Blue Cross, Blue Shield, Humana, those types of companies can't um subrogate.
• 23:34
  William Auten: They can in some states across the country.
• 23:36
  William Auten: I don't know which ones, but uh from what I understand, uh they are allowed to in some states.
• 23:42
  William Auten: And they used to be able to here in New York, and that changed.
• 23:46
  William Auten: I want to say that was around 2009 or 10, also, uh, where they they took that ability away from private health insurance companies.
• 23:55
  William Auten: And um, except in New York if it's an ERISA plan, which is basically a self-funded health insurance program through a large employer.
• 24:06
  William Auten: Um, those actually can subrogate.
• 24:09
  William Auten: Anyway, that's that.
• 24:11
  William Auten: Um, those are the the types of companies that can subrogate.
• 24:17
  William Auten: Are you okay?
• 24:18
  Chantal Roberts: Yeah, no, I'm um I'm lit I'm listening to you.
• 24:21
  Chantal Roberts: I'm also um I'm sure I'm making a face on YouTube and I'm not even paying attention because I'm I'm trying to be very subtle and send um Bill notes while he's talking.
• 24:37
  Chantal Roberts: Um because it yeah, and so I'm sure I'm making like this really stupid face going like completely forgetting that I'm on camera and that I'm being recorded.
• 24:48
  Chantal Roberts: Uh, because that is such as the day that I am having.
• 24:52
  Chantal Roberts: Um so he is absolutely right.
• 24:57
  Chantal Roberts: You gotta know kind of with the Medicare uh excuse me, Medicaid, what you're looking at.
• 25:04
  Chantal Roberts: I think in Arkansas, it was just like one, like the Arkansas Department of Health.
• 25:08
  Chantal Roberts: That's all you needed to look at.
• 25:11
  Chantal Roberts: But um there there is, like I said, just this this yeah, there's a whole thing.
• 25:17
  Chantal Roberts: And her county, that's really interesting.
• 25:20
  Chantal Roberts: I had not heard that before.
• 25:22
  Chantal Roberts: So it behooves you to know or at least maybe have a trusted AI, uh or excuse me, IA, independent adjuster who would know this um uh about their state or what have you if you if you work in a couple of different states.
• 25:43
  Chantal Roberts: Um the very uh me trying to be all stealth-like and everything, I was trying to send uh Bill the uh process, the recovery process for uh Medicare, the CMS issues, and and there's like a whole bunch, and I'm only limited to like 3,000 characters each, and so I like keep having to delete stuff because I keep loading too much in.
• 26:10
  Chantal Roberts: And yeah, so what welcome to the joys of podcasting?
• 26:15
  Chantal Roberts: Um, these are the things that people never talk about, and uh I just say, you know what, I don't edit these stuff out.
• 26:22
  Chantal Roberts: I mean, I I don't mind that you're driving in your car laughing at me.
• 26:26
  Chantal Roberts: I don't care.
• 26:28
  William Auten: Or this is a this is a really complicated topic because the like we we couldn't the the whole process of of reporting is is a whole tech side of things that we we just as an adjuster you don't really get involved in.
• 26:45
  William Auten: That's that's what the um you know the coo and the it department, their job and their compliance department, their job is to make sure that this is all done behind the scenes.
• 26:58
  William Auten: And um, but but there there are some practical things for adjusters to know when it comes time to handle a claim like this and settle a claim because that starts getting impacted.
• 27:10
  William Auten: When when you've got an elderly person on Medicare and they're not represented, and they have say$1,500 in out-of-pocket medical expenses, and they want to be reimbursed for that.
• 27:26
  Chantal Roberts: And that's a lot of money, even if it's not okay.
• 27:28
  Chantal Roberts: So, can I take a detour real quick?
• 27:31
  Chantal Roberts: Because again, uh I I always said, even to attorneys, I'm like, I don't care.
• 27:37
  Chantal Roberts: They could be three months old.
• 27:39
  Chantal Roberts: I I do not care.
• 27:41
  Chantal Roberts: I want all of the information because I'm going to run them through Medicare.
• 27:45
  Chantal Roberts: And um a lot of people protest this.
• 27:49
  Chantal Roberts: And you as adjusters need to understand that Medicare doesn't only take care of the elderly.
• 27:58
  Chantal Roberts: They can take care of end-of-life people.
• 28:01
  Chantal Roberts: You know, like if you had renal stage failure, uh if you like are have cancer, you could be on there.
• 28:08
  Chantal Roberts: They could take care of some of the survivors of uh the people who were on um Medicare, or at least they could.
• 28:18
  Chantal Roberts: Now that may have changed, but um, that's how you know you could sometimes get uh the 17-year-old who's perfectly healthy, but their parent wasn't or whatever.
• 28:30
  Chantal Roberts: And so they were like a beneficiary in in that sense.
• 28:33
  Chantal Roberts: That could have totally changed.
• 28:34
  Chantal Roberts: I don't know.
• 28:36
  Chantal Roberts: However, um that's why I'm saying doesn't matter.
• 28:42
  Chantal Roberts: Uh you gotta run them through.
• 28:43
  Chantal Roberts: And even if it's it's not just for Medicare we're looking at.
• 28:48
  Chantal Roberts: Remember, we just talked about Medicaid, we should be looking at Medicaid too.
• 28:53
  Chantal Roberts: Um, so that I'll turn it to the Yeah, always report it to those government entities.
• 28:58
  William Auten: That's not not even negotiable.
• 29:00
  Chantal Roberts: Yeah, no, it's not.
• 29:01
  Chantal Roberts: It is absolutely not.
• 29:03
  William Auten: Uh, there there is there is one exception.
• 29:06
  Chantal Roberts: Oh, there's always an exception.
• 29:08
  William Auten: That exception is if the settlement is less than 700$750 or less.
• 29:14
  Chantal Roberts: That I didn't even know.
• 29:15
  William Auten: So Medicare uh uh that's the small settlement provision.
• 29:20
  William Auten: They they don't want to be bothered with those.
• 29:24
  Chantal Roberts: Um, so we're getting ready to talk about how to settle a claim within when you come when Medicare, when CMS, Section 11, when all of that um comes back and says, yes, there's a Medicare eligible recipient, and we have made conditional payments, which was what Bill has been talking about.
• 29:44
  William Auten: Yeah.
• 29:44
  Chantal Roberts: This is a huge pain in the rear.
• 29:46
  Chantal Roberts: And I'm going to tell you, um, grandma, like Bill was talking about, when she's unrepresented, is not gonna understand this process because it sounds suspicious to me.
• 30:01
  William Auten: And it does, it just sounds like a delay tactic.
• 30:04
  William Auten: And it's absolutely not.
• 30:07
  Chantal Roberts: It it completely sounds like like you are taking advantage of them.
• 30:11
  Chantal Roberts: Um, I do have a flow chart uh with a with a um from the government um that I'm gonna put in the the the link in the the show notes, and um you can get it there.
• 30:25
  Chantal Roberts: But it's really nice to have.
• 30:28
  Chantal Roberts: I used to include that with my Medicare letter, my CMS letter that I would send to my claimant saying, this is the reason why I need it, and this is what's gonna happen if you come back, like with a quote unquote positive hit and everything, because it's gonna sound super sus, as the kids these days say, and it it it is completely not.
• 30:54
  Chantal Roberts: So, Bill, I'm gonna turn it back over to you.
• 30:57
  William Auten: Yeah.
• 30:57
  William Auten: So when you have that case with the elderly person who doesn't understand what you're talking about, doesn't care about what you're talking about, they just they got hurt, they think it's somebody else's fault, and they don't even want to sue, they just want their medical bills paid.
• 31:13
  William Auten: You still have to go through this process.
• 31:15
  William Auten: And if it's if it's more than$750, you've got to report it to Medicare, you've got to get that conditional payments letter, and you've got to explain to them look, if we settle this with you for$1,500, there's a$1,400 lien.
• 31:31
  William Auten: So you're only gonna get um$100.
• 31:36
  William Auten: Yeah.
• 31:36
  William Auten: So if you're out of pockets or$1,500, we're gonna add that$1,400 to it and we're gonna call it$2,900, and we're gonna make a release out to you for that much, but you're only gonna get a check for the part that we owe you.
• 31:51
  William Auten: The rest has got to go to Medicaid or Medicare.
• 31:54
  SPEAKER_01: Right.
• 31:54
  William Auten: Medicaid or Medicaid the same applies to both.
• 31:57
  SPEAKER_01: Right.
• 31:58
  William Auten: And that's the proper way to handle it because otherwise you're blindsiding this claimant with um an unrealistic understanding of where the money goes.
• 32:09
  Chantal Roberts: I think the part that really confuses them the most, and it confuses it confuses me.
• 32:17
  Chantal Roberts: And and this is what sounds like we are delayed, is okay, so of course, as most liability adjusters know, we can't settle until they finish treatment.
• 32:33
  Chantal Roberts: And there's a little caveat to that, but I'm not gonna get into it.
• 32:36
  Chantal Roberts: So they we can't settle until they finish treatment.
• 32:40
  Chantal Roberts: Okay, great.
• 32:41
  Chantal Roberts: So once they finish treatment, we have to go back to Medicare.
• 32:45
  Chantal Roberts: And we're just gonna call it Medicare.
• 32:48
  Chantal Roberts: Just know that we're talking about Medicaid as well.
• 32:51
  Chantal Roberts: But we got to go back to them and say, okay, the claimant is finished treating.
• 32:55
  Chantal Roberts: What is your final kind of demand here, your conditional demand?
• 33:00
  Chantal Roberts: And they're gonna go, okay, so we're gonna tattly everything up, and this is what we think that that is owed to us.
• 33:05
  Chantal Roberts: Is that what you come up with?
• 33:06
  Chantal Roberts: And we're gonna go, yeah, sure, that's what we come up with, you know, go ahead.
• 33:10
  Chantal Roberts: And then they're going to send us, you know, they being Medicare, the government is gonna send us a demand.
• 33:18
  Chantal Roberts: Great.
• 33:19
  Chantal Roberts: We would you know pay that, but we we also need to get that release, right?
• 33:27
  Chantal Roberts: And and like Bill said, you include those medicals in the release because you're gonna pay the whole thing.
• 33:32
  Chantal Roberts: But if you're um if you're giving a release over to the claimant, they think that they're gonna get the check like right away, but there's like a long intermediary part there where the government is checking things and then they give you a final demand because they don't even give you a final demand until they it it's it's a whole thing, guys.
• 33:57
  William Auten: It's it's it's hard, it's hard sometimes.
• 33:59
  William Auten: Sometimes it goes quick.
• 34:01
  William Auten: Yes, other times they say, you know, right now it's here, but there's more pending in so many words in their conditional letter.
• 34:09
  William Auten: And and and you need to think about this as a lean against the settlement.
• 34:14
  William Auten: It's right, it's and it's not just a demand like my hands out.
• 34:19
  William Auten: It's it's whatever you pay to them, we're gonna take a piece of it.
• 34:23
  Chantal Roberts: Yes.
• 34:24
  Chantal Roberts: So um and yeah, so um it's not like you can settle yet because now you're waiting on the government.
• 34:32
  Chantal Roberts: And I will say this, they have gotten a lot faster.
• 34:35
  Chantal Roberts: I mean, back in the day, like 2009, 2010, 2015, I mean, it took a month, two months, something like that.
• 34:44
  Chantal Roberts: I mean, it took a long time.
• 34:45
  Chantal Roberts: Meanwhile, grandma's over here going, look, I just want my$1,500.
• 34:49
  Chantal Roberts: I can't make you know, rent, or I can't buy my medicine, or I can't do this or that, or whatever.
• 34:54
  Chantal Roberts: Because meanwhile.
• 34:56
  Chantal Roberts: Yeah, because meanwhile, all of this meds they still keep coming up to um Medicare, and Medicare is then running all of the new meds against the date of loss, and you know, the CPT codes and the ICD 10 codes and all of that, making sure that it the new bills aren't related to the old injury and need to be added to the demand.
• 35:24
  Chantal Roberts: Do you see how confusing this is?
• 35:26
  Chantal Roberts: It sounds suspicious, and now you know you're trying to explain this to grandma who doesn't trust you because you're just some voice from you know Wisconsin or whatever, you know, I don't know.
• 35:39
  Chantal Roberts: Um, so yeah.
• 35:42
  Chantal Roberts: So finally, all said and done, you get the final demand letter.
• 35:46
  Chantal Roberts: Okay, woo! So you pay it and um you can settle with your claimant, being that it's$2,900, we're gonna give you$1,500 because the rest had to go to you know, Medicare or whatever, and then boom, you're done finally, yay.
• 36:06
  Chantal Roberts: Um, but you have to sign that release first before I and it yeah, it's a whole thing.
• 36:13
  Chantal Roberts: And it is a whole thing.
• 36:14
  Chantal Roberts: And then let's say that Medicare, Medicaid, they make mistakes, they accidentally add some things on that you don't think is covered.
• 36:25
  Chantal Roberts: Here's the fun thing about this adjusters it is it behooves you as the insurer, and I know that you're not the insurer, but it behooves the insurer to pay it because again, I mentioned there's a thousand dollar a day fine if you don't pay it per claim.
• 36:44
  Chantal Roberts: So, what I was always told uh was you pay the whole thing, and then then you file the appeal or the contestment of that particular part because you do not want to be fined a thousand dollars a day.
• 37:06
  Chantal Roberts: And allegedly, and I've never known anyone.
• 37:09
  Chantal Roberts: If you have, please let me know.
• 37:11
  Chantal Roberts: Please write it in the show notes, send Bill and me an email, whatever.
• 37:15
  Chantal Roberts: I have never known anyone who has appealed anything, but allegedly the government gives you your money back.
• 37:22
  William Auten: I I've not um I'm not familiar with any companies that have uh have been fined.
• 37:28
  Chantal Roberts: Uh I'm not saying that they haven't been, but what I heard was what I heard was uh we all had that grace period up until I think 2024 was a long time.
• 37:40
  Chantal Roberts: It was like we had a really long grace period because the government was like easing us into this, and I think the grace period ended in 2025, and so they started now, but I always operated as if the fines were active right then and there because the the government could, like I said, um they told me that they could go after anybody, the attorneys, us, the third party administrator, doesn't matter.
• 38:10
  Chantal Roberts: Uh I know it's supposed to be the RRE, but it could be anybody.
• 38:14
  Chantal Roberts: And the RRE is usually the insurer.
• 38:17
  Chantal Roberts: Okay, so anyway, um that is the other thing that I wanted to drill into people is um make sure that the payment gets done and then you can contest later.
• 38:29
  Chantal Roberts: But if you know of someone who contested it, let me know because I I hear you're supposed to get your money back.
• 38:38
  Chantal Roberts: That's true.
• 38:39
  William Auten: So there's um there's another way to handle um handle this, and it's not uh something I would recommend, but in strange cases where it makes sense to settle and and you and you don't know whether they have Medicare or Medicaid, if you explain to them that look, if you have either of these uh and we pay you directly, you are going to owe it because we're gonna put in our release that you are responsible, then we're gonna transfer that responsibility to you and you're gonna sign this release that says you agree to that.
• 39:17
  William Auten: So if we settle with you for ten thousand dollars and a year from now, after you signed a release, you get a call from Medicare or we get a call from Medicare saying that there's two thousand dollars owed to them, um, we're going to send them your contact information and and you and a copy of the release that you signed, and then you will have to pay that out of the funds that you um but it the the I've never really seen anything uh happen like most of the carriers I work with uh use releases with that language in it.
• 39:53
  Chantal Roberts: In it anyway.
• 39:54
  Chantal Roberts: I have told attorneys who refuse to give me that information.
• 39:58
  Chantal Roberts: I'm like, okay, well, I'm gonna need you to sign a hold harmless and indemnification.
• 40:04
  William Auten: Right.
• 40:04
  William Auten: You know, because you're gonna that's the that's about the only example where if you get a belligerent claimant or attorney that won't share the information.
• 40:12
  Chantal Roberts: Yes.
• 40:13
  Chantal Roberts: Um and and I hate to say this a lot of times, but sometimes you can get the information from uh this the the medical bills, you know, because they they'll have the um social security number especial.
• 40:33
  William Auten: Medical records sometimes will have it.
• 40:35
  William Auten: If if they refuse to give it to us, we'll we'll review everything that we have because sometimes it it is buried in there.
• 40:42
  William Auten: And remember that's PII people.
• 40:44
  William Auten: That means that is private information.
• 40:46
  William Auten: So don't email it to each other and uh don't email social security numbers to each other.
• 40:51
  William Auten: I get that from attorneys all the time.
• 40:52
  Chantal Roberts: Yeah, yeah.
• 40:53
  William Auten: I'll leave a message hey, I just call in to see if I can get the insurance, uh the claimant's social security number.
• 40:59
  William Auten: Ten minutes later, I'll get an email.
• 41:01
  William Auten: Oh, here's the social security number you asked for.
• 41:03
  William Auten: It's like, are you kidding me?
• 41:05
  Chantal Roberts: Can't do that.
• 41:06
  Chantal Roberts: Um, yeah, so we we've talked about the ethicalness of that, and that is that's a huge part.
• 41:15
  Chantal Roberts: Uh the PPI, personal protected information.
• 41:19
  Chantal Roberts: Um is of course part of that big five, which you know is name, date of birth, gender, so security number, uh, address, all of that kind of thing.
• 41:31
  Chantal Roberts: Uh, it are the things that needed to be identifiable to you.
• 41:37
  Chantal Roberts: And and again, explaining this whole process to someone who is automatically uh opposed to you because property adjusters, y'all know that the insured already thinks that you're not gonna offer enough money for the roof or the car or whatever, but the liability adjusters get a whole different set of it, you know, because um, you know, they're it's it's kind of the same thing.
• 42:08
  Chantal Roberts: They're mothers, next door neighbors, aunts, best friends, third grade teachers, ex-husband had the exact same, you know, injury as as you, and they got$50 billion, or right, you know, whatever.
• 42:24
  Chantal Roberts: It's gonna be that same set, but it is automatically 10 times as worse as I felt as a liability adjuster compared to a property adjuster.
• 42:39
  Chantal Roberts: And that is because a lot of it is subjective, such as the pain and suffering uh that we that we do.
• 42:46
  Chantal Roberts: And so now we're coming in with something else that that sounds even more suspicious, like this government entity, and they're going to first send you a conditional demand, and then they're going to think about it, and then they'll send you a final demand.
• 43:00
  Chantal Roberts: And meanwhile, I can't settle until I get all of this, and then I got to pay them, and then I'm gonna pay you the difference.
• 43:08
  Chantal Roberts: You know, it just it sounds super suspicious.
• 43:12
  Chantal Roberts: So if you have the letters and uh even pointing, I think, claimants to the websites, the governmental websites, so that they can read it and understand what you are up against is is very helpful.
• 43:31
  William Auten: My my advice is to learn all you can about it so that you can verbalize what's going on in layman's terms to the average Joe, because that's who you have to communicate this to.
• 43:47
  William Auten: And you can't do it using acronyms and word salads and alphabet soup.
• 43:53
  William Auten: You've got to be able to describe the process from start to finish, and you have to remember.
• 44:00
  William Auten: That in their mind, they're going to be thinking this is just a delay tactic, they just don't want to pay anything, they're trying to pay as little as possible and they're trying to stretch this out as long as they can.
• 44:09
  William Auten: Not the case.
• 44:11
  William Auten: We would rather get all of the claim information on day one so we can close it on day two.
• 44:17
  William Auten: This is a busy job, you know.
• 44:19
  Chantal Roberts: Exactly.
• 44:20
  Chantal Roberts: And you know, you mentioned that, and uh to all the CEOs who are listening, um, not that there are any, but that's okay.
• 44:28
  Chantal Roberts: Uh, you know, there was this huge push, what, about 10 years ago, to do that first call settlement or whatever.
• 44:36
  Chantal Roberts: And uh I remember when that was coming out, and I'm like, you know, that doesn't work anymore with Medicare and Medicaid because we still gotta go run them through.
• 44:47
  Chantal Roberts: And so there isn't this no, and I don't know if that's still going on.
• 44:51
  Chantal Roberts: I guess if it's under that$750, but I don't I have actually never had any success with this first call settlement.
• 45:01
  William Auten: Um so here's another thing that happens with the$750 uh threshold.
• 45:07
  William Auten: When you explain that to someone, they instantly think, oh, he's just trying to get me to settle for$750 when my claim is clearly worth more than that.
• 45:18
  William Auten: Right.
• 45:19
  William Auten: It's it just puts us in such a box, and it's no wonder that there's these stupid books that come out, you know, complaining about denies and you know, yes, delays saying the name of the book, but uh yes, exactly.
• 45:33
  William Auten: Um it it it puts us in a real spot, and it's not the insurance companies that have done it as much as it's regulatory that has really, you know, they it happens with a lot of government programs, they think they're trying to help and they're really just making things worse.
• 45:53
  Chantal Roberts: Yes.
• 45:54
  Chantal Roberts: Um, so I'm I'm going through my notes um real quick just to see.
• 45:59
  Chantal Roberts: Um reporting requirements, just to make sure.
• 46:03
  Chantal Roberts: I know we've been jump jumping around a little bit, but I just want to make sure that we've kind of touched about um all of the things.
• 46:09
  Chantal Roberts: Um reporting requirements, the liability insurance, no fault insurance, workers' compensation.
• 46:17
  Chantal Roberts: You had mentioned all of those.
• 46:19
  Chantal Roberts: Bill, Bill is much more uh uh in touch with that since he does a lot of the liabilities.
• 46:26
  Chantal Roberts: And it's been years since I've been in liability.
• 46:29
  Chantal Roberts: I love liability, it's fun.
• 46:31
  Chantal Roberts: Um, I I do think it's a lot of fun.
• 46:33
  Chantal Roberts: I will put I will I will give you the the flow chart, which I think is absolutely fantastic to offer to claim it's and it's it's the government's, it's not mine, it's it's not anything.
• 46:45
  Chantal Roberts: So I mean, there's no problem with giving that information um away.
• 46:50
  Chantal Roberts: And um yeah, so story time real quick.
• 46:55
  William Auten: And yes, uh before we wrap up, we had um claim about a year or two ago.
• 47:00
  William Auten: The attorney, the attorney said he submitted the um some medical bills for a person who was on Medicare.
• 47:10
  William Auten: And he said, can you just pay these out of Medpay?
• 47:14
  William Auten: And there's I've heard some carriers argue that MedPay doesn't count.
• 47:18
  William Auten: I don't think that's the case.
• 47:19
  William Auten: I think MedPay uh it goes into the same bucket as everything else that if you pay on med pay without paying Medicay, Medicare first, you're in hot water.
• 47:30
  William Auten: Nonetheless, um he said, just you know, can you just pay these?
• 47:34
  William Auten: And I said, No, we can't.
• 47:35
  William Auten: We have we first we have to get the the big five as you call it.
• 47:40
  William Auten: And uh and he said, why?
• 47:42
  William Auten: And I said, we have to report it to Medicare, to CMS.
• 47:45
  William Auten: He goes, No, no, no, I don't want that.
• 47:47
  William Auten: I said, I don't care.
• 47:49
  Chantal Roberts: Do not care.
• 47:50
  Chantal Roberts: Thousand dollars a day fine.
• 47:51
  Chantal Roberts: Do not care.
• 47:52
  William Auten: It's not an option for you, Bob.
• 47:53
  William Auten: Uh so uh I I had to and I think what his mind was his mind was more along the lines of the way um no fault and loss transfer work in auto claims, because I think he primarily did auto.
• 48:10
  William Auten: I I don't know.
• 48:11
  William Auten: I don't know where the confusion came and why he didn't know this, but anyway, um, so you you have to watch for that.
• 48:18
  William Auten: Not like attorneys are smart folks, but sometimes they wander into this realm of of claims and and cases that they're not really familiar with, and you have to kind of just educate them a little bit.
• 48:32
  Chantal Roberts: Yeah, and I would I would agree with you, Bill, that the the the government says no fault.
• 48:39
  Chantal Roberts: So to me, that is pip, that is med pay, that is, you know, slipping you the the med pay that we have in our homes.
• 48:48
  Chantal Roberts: I mean, this we're we're I think we're kind of giving the impression that this is only like auto or commercial or whatever, but this can happen in your homeowners claims as well, you know.
• 49:01
  William Auten: Commercial general liability, your home, even if you're a renter.
• 49:04
  Chantal Roberts: Yes.
• 49:05
  Chantal Roberts: Um worker's comp.
• 49:06
  William Auten: If you're asking me how many dog bite claims we have with renters, you know.
• 49:10
  Chantal Roberts: Yeah.
• 49:11
  Chantal Roberts: So yeah, yeah.
• 49:12
  Chantal Roberts: So uh you have a workers' comp claim.
• 49:15
  Chantal Roberts: It that is specifically mentioned.
• 49:17
  Chantal Roberts: So uh these are things to to understand.
• 49:21
  Chantal Roberts: So uh you know, identify our lien holders early, get that big five information, the key, the the personal identification information uh early uh so that we can turn that over to if we're the independence, either the insurance company or put it into our system and then let it go.
• 49:47
  Chantal Roberts: Because again, I don't want the adjusters to worry too much about it because they don't they're not the ones who usually call Medicare or Medicaid or whatever.
• 49:55
  Chantal Roberts: It's someone that the insurance company's contracted with.
• 49:59
  Chantal Roberts: And then once you get the letter back or you get the answer back, yay or nay, you know, that's when you need to know which way you need to go.
• 50:10
  Chantal Roberts: And uh of course, you've already explained all of this to the claimant on your first call why you're asking this information.
• 50:18
  Chantal Roberts: You've sent out a letter, and so you can even, when you get the information back, call the claimant up and go, hey, I I've gotten a positive hit on you.
• 50:28
  Chantal Roberts: You know, you're you Medicaid and Medicare, whatever is is paying this.
• 50:34
  Chantal Roberts: So this is going to impact how we settle.
• 50:36
  Chantal Roberts: You might want to explain it right then and there, because again, it sounds sus.
• 50:40
  Chantal Roberts: It sounds really suspicious.
• 50:42
  William Auten: Um and and and there's no quarrel with reimbursing Medicare for the city.
• 50:47
  William Auten: No, no, no, no.
• 50:48
  William Auten: It's not that's not what is annoying about this whole process.
• 50:52
  William Auten: The the part that's annoying is that it forces you to have conversations with claimants that make it sound like you're trying to delay because it they've imposed this delay thing on us now, and that we we have to comply.
• 51:09
  William Auten: That's the annoying part.
• 51:11
  William Auten: The reality is I want to know how much Medicare has paid in medical because if we get a demand from an attorney for a million dollars and we get a Medicare lien for 2,500 bucks, kind of changes the outlook on the claim, doesn't it?
• 51:27
  Chantal Roberts: Yeah.
• 51:27
  Chantal Roberts: So absolutely, yeah.
• 51:29
  Chantal Roberts: Um, so again, you know, of course, you know you're gonna document all your conversations, you're gonna do that anyway.
• 51:34
  Chantal Roberts: Uh, I would just make sure that that uh your notes are very clear and um I would resist letting people know that um they can settle themselves because again, it's the insurer.
• 51:54
  Chantal Roberts: Although I've always been told the government can go after whoever they want, um, it's the insurer who is ultimately responsible.
• 52:01
  Chantal Roberts: And we're talking about$1,000 a day fine.
• 52:03
  William Auten: Do you mean uh do you mean a uh property owner settling with a claimant?
• 52:07
  Chantal Roberts: No, no, no, no, no.
• 52:08
  Chantal Roberts: Well, they're not supposed to do that anyway.
• 52:10
  Chantal Roberts: I'm talking about like if the if the attorney and and I had many an attorney say to me, I will settle with Medicare myself.
• 52:17
  William Auten: Oh, oh, I see.
• 52:19
  William Auten: And you well, that's where the release comes in.
• 52:21
  Chantal Roberts: Yes, and and usually what um that what the attorney is wanting to do, and I don't think I'm putting out any kind of things that that the attorneys don't want us to know and that no adjuster doesn't already know, is that they want to try to negotiate that lien down, just like the the attorneys want to settle with the doctors themselves.
• 52:45
  Chantal Roberts: Uh, they try to negotiate the doctor's bills down, which puts more money in their client and their pockets, which is, I mean, fine.
• 52:55
  Chantal Roberts: I don't I don't care as long as my claim is is settled, I've paid the fair amount, my my client, which is the insured, is protected, you know, uh and and everything.
• 53:07
  Chantal Roberts: That's what I care about.
• 53:09
  Chantal Roberts: So um, yeah, uh that's when, as you and I talked about, I I I would not let the attorney do that, or the claimant if that's what the claimant wants to do the with Medicare CMS themselves.
• 53:22
  Chantal Roberts: I would want to hold harmless.
• 53:23
  William Auten: It's a risk, it's a risk.
• 53:25
  Chantal Roberts: Yeah, I would want to hold harmless and indemnify.
• 53:27
  William Auten: Yeah, and unless that's a very sophisticated claimant that maybe is an attorney, or I don't even know if I would trust them then.
• 53:35
  Chantal Roberts: I I would run that up the flagpole anyway.
• 53:39
  Chantal Roberts: Um, yeah.
• 53:41
  William Auten: Just new our next topic.
• 53:44
  Chantal Roberts: Oh my gosh, our next topic in in two weeks.
• 53:48
  Chantal Roberts: I'm sorry, I keep going on.
• 53:50
  Chantal Roberts: Um, is how to do a good recorded statement.
• 53:53
  Chantal Roberts: I thought that would be we we mentioned that a couple of of episodes ago, like uh we did we did one on that um a while back and it was very popular.
• 54:02
  William Auten: So I I think uh a reboot uh would be a good idea.
• 54:05
  Chantal Roberts: Oh, I didn't even I see this is this is me.
• 54:08
  Chantal Roberts: I I don't remember what happened yesterday, so I don't even remember doing that.
• 54:13
  William Auten: So whoops, you were awesome in that one, by the way.
• 54:15
  Chantal Roberts: Was I really?
• 54:16
  Chantal Roberts: I think I find that really hard to lame.
• 54:19
  Chantal Roberts: But okay.
• 54:20
  Chantal Roberts: Um, yeah, so uh anything else?
• 54:26
  Chantal Roberts: Um yeah.
• 54:28
  Chantal Roberts: Like, subscribe, listen, share, let us know, questions, whatever.
• 54:35
  William Auten: Follow us on LinkedIn.
• 54:36
  William Auten: Yes, send us liability claims here at Ot and Claims Management.
• 54:41
  Chantal Roberts: Uh send me expert witness claims at CMRconsulting.net.
• 54:46
  Chantal Roberts: Or yeah, hire me as a teacher or whatever.
• 54:50
  Chantal Roberts: I'm so entertaining.
• 54:54
  Chantal Roberts: All right, we'll talk to you later, Bill.
• 54:56
  William Auten: All right, take care.
• 54:57
  William Auten: Bye-bye.
• 54:58
  William Auten: Thanks for joining us on the Art of Adjusting Podcast, where we talk about life as an insurance adjuster.
• 55:03
  William Auten: Hit that subscribe button real quick and tell all of your adjuster friends to check this out as well.
• 55:08
  William Auten: For independent adjusting services, go to www.autin.claims.
• 55:12
  William Auten: And for anyone interested in working as an independent liability adjuster, go to the contact us tab to join our roster.
• 55:21
  Chantal Roberts: So this wraps up another Art of Adjusting podcast.
• 55:24
  Chantal Roberts: If you enjoyed this podcast or this episode, please give us five stars and a review.
• 55:30
  Chantal Roberts: It does help the algorithm pick us up.
• 55:33
  Chantal Roberts: In the meantime, you can contact me at theartofadjusting.com for consulting and training purposes.